Advice please with issues at 9 months (long)

Juliebird8307 · June 2014

I've posted before about weight gain/supply issues and always seem to do alright for a little while after getting advice. DD is 9.5 months now. She had low weight gains twice now at her doctors appointments (once at 6 months but much better at 7 months and again at 9 months). She liked baby food about 1/5 times that we gave it to her. But she loves puffs so we just started concentrating more on 'real' food yesterday. The dr said to try to BF only half the amount (or give half a bottle) then give her food, then try to finish BFing or bottle. That has somewhat worked (only been doing this for a few days). We go back in 5 weeks for a weight check. I have several questions about supply, how much milk she should be getting, how much food she should have, etc. Here is our typical day:

7:30 - feeds on one side, I pump both sides after, getting usually 5-6 ounces, but sometimes only getting 4oz (I get about .5-1oz from the side she fed from)
8:30- try solids (cereal, yogurt, fruit). The last week she hasn't wanted any 'liquid' types of food
11:30 -pump or BF, she gets 5oz bottles, lately I'm only pumping about 4oz in 30-35 minutes. We try to do food in the middle of this
3:30 - BF usually. Haven't done this pump in a while so I'm not sure how much I'm getting. She seems to be getting frustrated quickly but is fine after I stop trying to put her back on the breast.
6:30 solid for dinner, sometimes I BF before.
7:45 BF before bed.

This has mostly been our schedule for several months. I'm concerned that I'm pumping much less than I used to, but maybe that is normal at this point. If my supply is dropping, should I stop that morning pump and will that 'save up' more for later? Or does it seem like I should be supplementing at this point? I do have a decent freezer stash to supplement with. If I should try to supplement, how would I go about doing this (replace a BF session with bottle, or give pumped milk after BF)? Does it seem like I should be focusing more on solids and just go with the flow on the BM? I appreciate any advice. I'm just lost on what I should be doing. Dr seemed to want me to focus on food more, which we started this week. I'm just not sure now if she's actually eating enough solids to make up for a drop in supply.

Edit: sorry about the format. I'm mobile

surpriseaddition · June 2014

I also had a dip in supply around 9 months. I just started hitting the freezer stash. I don't know your definition of "decent" supply, but I had almost 300 oz, and some of them were started to get kind of old (3-4 months in there). My LO was taking 3 - 5 oz bottles each day, but I was only pumping about 10 oz at work. Therefore, I was sending in a 5 oz frozen bottle each day. At 25 oz for the week, I was able to make it 12 weeks before my freezer stash ran out. This coincided with her turning one year, and introducing WCM. You need to use your stash at some point. If she's struggling with weight gain, I'd be giving more milk personally.

Juliebird8307 · June 2014

theresat858 said:

So she is only getting breastmilk at 7:30, 11:30, 3:30, and 6:30/7:45? Does she still nurse at all overnight?
4 feedings a day doesn't seem to be enough for a 9 month old, particularly one who is having trouble gaining weight.

I would aim to breastfeed at least every 3 hours during the day. If you are concerned about your supply, dropping a pumping session will not help that. I do not think it is a supply issue, though, particularly given you seem to be pumping, what, 3 extra ounces per day? (4-6 in the am, 4 at 11:30, and baby is only getting 5 ounces in a bottle total?).

Before 1, the majority of calories should still be coming from breastmilk, and if baby is getting 5 ounces per feeding session, then baby needs at least 5 feeding sessions/day to get to the average 25 ounces/day.

Food is necessary as a supplement, but it's just that - a supplement. When weight is a concern, I would avoid all foods that are not calorie-dense. Drop the puffs, even if baby seems to like them. They are nutritionally void and will fill her up on low-calorie food. Yogurt is a good choice. Fruit is ok in limited amounts. Bananas are good as far as fruits go. Avocado is great if your LO will eat it (mine wouldn't, though now she'll eat guacamole). Add coconut oil to oatmeal to add some healthy calories, and prepare any oatmeal/rice cereal with breastmilk rather than water. Focus on proteins and fats, not carbs.

And add a feeding session. That should help with both your supply and baby's weight gain.

Thanks for your advice. I do nurse her more often on the weekends when I'm with her all day. DD has slept through the night since 4 months, so I do not feed her at all in the night. The reason that I feel that I am having issues with my supply is because if I do pump during the 3:30 feed, it's usually only 3oz. That makes me think that I am not producing enough milk later in the day for her. I know my mornings are fine, but I'm concerned with the last two feeding. And if I pump on the weekend after she eats at 7:30, am I really making enough for her to eat at 11:30 (since I haven't been pumping 5 ounces)? And technically, if she only eats 4 times a day, she should be getting 6 ounces.

The problem with solids is that it's nearly impossible to get her to eat anything. She's doing OK with Cheerios and some fruit. She used to like avocado but she can't pick it up and lately she doesn't want to be fed. It's really been a struggle to get her to eat solids. Her dr did say that she never likes to recommend to replace BM or formula for solids, but she thinks that she needs to get more used to them.

surpriseaddition said:

I also had a dip in supply around 9 months. I just started hitting the freezer stash. I don't know your definition of "decent" supply, but I had almost 300 oz, and some of them were started to get kind of old (3-4 months in there). My LO was taking 3 - 5 oz bottles each day, but I was only pumping about 10 oz at work. Therefore, I was sending in a 5 oz frozen bottle each day. At 25 oz for the week, I was able to make it 12 weeks before my freezer stash ran out. This coincided with her turning one year, and introducing WCM. You need to use your stash at some point. If she's struggling with weight gain, I'd be giving more milk personally.

I have about 500oz in my freezer stash. If you replaced a bottle each day during the week, what did you do on the weekends when you were with your LO all day? Did you supplement with any BM? Did you need to supplement at night at all on week nights? That's my biggest concern right now. I'm fine with sending frozen milk to her babysitter's, but I'm worried about if she is getting enough milk from me when she BF.

opheliainwaders · June 2014

Agreed with PPs, and a few more thoughts.

When you're together, are you feeding on demand, or trying to mimic the DC schedule? If the latter, then switch to feeding on demand. If LO doesn't get much at a feeding, she'll simply eat again sooner. I would not supplement when you're together, but I would make sure she's getting enough at DC by sending frozen milk if needed, and check that they're feeding her when she's hungry, not trying to "stretch" her feedings out to 4 hours. Maybe send more, smaller bottles?

Finally, I really don't think you have a supply issue, as the volumes you're pumping seem totally normal.

That said, for reference, at 9.5m, my DD was nursing 7-9 times per day on days when we were together, and taking 12-14oz/day of milk (and formula - I had to supplement sometimes). I would pump 3x in each work day. I didn't produce we'll for the pump, but didn't need to supplement when we were together.

The trick now is to feed BM on demand AND intro solids. Let her eat solids about an hour after nursing or getting a bottle, and don't worry too much about volume - she really shouldn't drop a feeding yet (and I'd get a second opinion from an LC if your pedi expects that).

surpriseaddition · June 2014

Like post above suggested, I always fed on demand on the weekends. This actually helped me with my supply. She would nurse a lot over the weekends, because I didn't supplement with frozen on the weekend. Usually on Mondays I'd get an extra ounce or two pumping, but by Friday it would drop again. I was happy that I was able to do just BM until a year. At that point I started only pumping once per day at work (only getting about 3.5 oz) and DC used that as a small first bottle. But, at that point she was pretty well established on food. They then gave her one bottle of WCM before her afternoon nap. The rest of the time she drank water from a sippy. LO will be 14 months on Monday, and I'm just BF on demand and giving water now, since I'm a teacher and off for the summer. I have NO freezer stash at all....but after a year, you really don't need it. There are so many other liquid options, so I'm comfortable with that. I know I was hesitant to use that stash since I worked so hard to create it....but that is what you have it for. And, just because you're using it modestly doesn't mean your supply will diminish When you've BF for a long time, most moms can get down to just nursing morning/night and still have a supply for those nursing and not dry up. GL!

Juliebird8307 · June 2014

Thanks for the advice! The pedi didn't want us to drop a feeding, she wanted us to try food in the middle of the feeding so that she wasn't too full to eat solids. 90% of the time when we go to give her solids, she pushes us away, blows raspberries, cries, etc.

When I'm with her on the weekends, I feed on demand. But a lot of the times she will go 4 hours before getting hungry. Sometimes she can go longer, but i don't let her go longer than 4 hours. DD is tiny (14lb 10oz at her 9 month appointment) so maybe she just doesn't need a ton of food?? But then when I've been feeding her in the evenings, she will nurse for several minutes and push me away and start crying. That's making me think she's getting frustrated because there isn't enough milk.

Her babysitters (all except the one that watches her one day) feed on demand. I always send extra milk but they rarely need it.

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Advice please with issues at 9 months (long)

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